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Gynecological cancer survivors are affected in all aspects of their lives such as sexuality, reproduction, embodiment, self-esteem, and general quality of life. In this thesis a complex intervention study was performed for gynecological cancer survivors in which the effects of two arts-based psychotherapy treatments (individual and
group) on psychological outcomes were evaluated.

By Margareta Wärja

Gynecological cancer survivors are affected in all aspects of their lives. Cancer impacts sexuality, reproduction, embodiment, self-esteem, and general quality of life. The aftermath of illness and its treatment are often long-lasting. A complex intervention study was performed for gynecological cancer survivors (N = 57) involving one two-year qualitative preparatory phase leading up to a randomized trial in which the effects of two arts-based psychotherapy treatments (individual and group) on psychological outcomes were evaluated.

Clinical characteristics at baseline revealed high self-assessed psychological stress. It was hypothesized that when relationally contained in a therapeutic context, participants would explore a wide range of emotional suffering as a result of cancer, such as unresolved grief, unexpressed feelings, fears of dying, and bodily stigmas. This study presents the effects of arts-based psychotherapy on body image, sexuality, fear of cancer recurrence, and existential distress. A method called KMR–Brief Music Journeys was implemented in group and individual formats. This approach is founded on a preconception of body and mind as a connected unity. The theoretical frame for how the intervention may cause change was based on a psychodynamic and existential theories of implicit, unconscious, and affect regulating processes. The arts-based treatment approach applied in this study is founded on theories of phenomenology, psychodynamics, and affect regulation, and the use of the arts as vehicles for nonverbal communication and emotional content.

Our results showed a significant decrease in existential distress, and significantly improved bodily well-being for both approaches. Effect sizes ranged from medium (d = 0.47) to large (d = 0.83). The positive findings were sustained at seven-month follow-up. Bodily well-being, existential distress and quality of life were significantly improved. We found that a supportive and nonjudgmental group therapy approach was particularly helpful in providing a safe space for addressing previously unaccepted feelings such as bodily shame, and low self-esteem. To conclude, artsbased psychotherapy after gynecological cancer can decrease psychological distress and improve overall QoL significantly. Further research and clinical implementation is strongly recommended.

This thesis is built on six papers (presented below) and one linking text. Three papers relate to background literature and clinical methods, and three to results. Of the latter, two present findings from the randomized trial, and one paper shows evaluations of body image paintings using a new assessment tool.